DONALD J. ORTNER

Smithsonian Institution, National Museum of Natural History, Department of Anthropology, Washington, DC

HISTORY OF THE FIRST EDITION

The first edition of this book was the result of a joint collaboration between Dr. Walter G. J. Putschar and me. Dr. Putschar was an internationally known, consultant pathologist at Massachusetts General Hospital in Boston, Massachusetts, who had a special interest in diseases of the human skeleton. We began our professional relationship in 1970 when he accepted my invitation to be the principal lecturer in a seminar series on human skeletal paleopathology that I was organizing at the Smithsonian Institution. The first Paleopathology Seminar Series was held in 1971 and brought several leading authorities on skeletal disease, paleopathology, and related subjects to the Smithsonian Institution to present a series of lectures to a select group of scholars interested in skeletal paleopathology.

The seminar series was held yearly through 1974. By that time the logistics of obtaining funds to offer the series, arranging for students to come from many universities, including those outside the United States, and assembling an outstanding faculty for the 10-week series of lectures and laboratory sessions raised serious questions about whether this was the most cost-effective method for enhancing the quality and direction of research in skeletal paleopathology. It also highlighted the need for a comprehensive reference work on diseases of the skeleton that might be encountered in archeological skeletal remains. I discussed this issue with Dr. Putschar and we decided that many more scholars interested in skeletal paleopathology would have access to the substance of the seminar series if the information in the lectures and laboratory sessions was incorporated into a well illustrated and comprehensive reference work on pathological conditions that affect the human skeleton.

In the summer of 1974, with the support of a grant from the Smithsonian Research Foundation (now the Smithsonian Scholarly Studies Program), Dr. Putschar and I, accompanied by our wives, Florence Putschar and Joyce E. Ortner, and my three children, traveled extensively in Great Britain and several European countries for more than three months visiting educational and research centers that had significant collections of documented human skeletal pathology. In selecting these centers we leaned heavily on the advice of the late Dr. Cecil J. Hackett, a physician who had worked for several years in Uganda where he had treated hundreds of patients suffering from yaws. This experience led to a research interest in treponematosis, and Dr. Hackett wrote his doctoral dissertation on the clinical, radiological, and anatomical manifestations of yaws (Hackett 1947). Following his career in Uganda, Dr. Hackett settled in England where he continued his research on treponematosis, its history and skeletal manifestations. As part of this research he visited many of the major European collections of anatomical pathology that contained documented cases of syphilis. Hackett’s research on these cases resulted in the publication of his classic monograph (Hackett 1976) on the skeletal manifestations of syphilis, yaws, and treponarid (bejel). His knowledge of these collections and which ones were likely to serve the objectives Dr. Putschar and I had set out to achieve was an invaluable asset.

During our visit to these institutions, Dr. Putschar and I studied and photographed hundreds of cases of skeletal disease. In addition to the photographic record we made of these cases, we often were able to obtain autopsy or museum records that provided descriptive details and a diagnosis for the cases. Radiographic films were acquired for some of the cases. Dr. Putschar dictated his observations about each case and these observations were subsequently transcribed and organized by Mrs. Putschar. In some cases Dr. Putschar’s diagnostic opinions were at variance with the diagnosis given in the catalog and this difference was duly noted in his observations. Most often, however, the diagnosis given in the catalogs was plausible if not reasonably certain.

We began the task of writing the book shortly after completing our European research in 1974. In 1979 we submitted the completed manuscript to the Smithsonian Institution Press for publication as part of the Smithsonian Contributions to Anthropology series. The manuscript was reviewed by the Department of Anthropology, external reviewers, the Director’s office of the National Museum of Natural History, and the Press. After approval on all levels, editing and production took an additional several months and the book was published in December of 1981 as Smithsonian Contributions to Anthropology, Number 28. A hard-cover edition was published in 1985 that was identical to the first edition except for the addition of an index.

HISTORY OF THE SECOND EDITION

Since Dr. Putschar and I completed the manuscript for the first edition, much has changed in the study of ancient skeletal diseases. The Paleopathology Association, established in 1973 with fewer than two dozen members, is now a thriving international scientific association with more than 600 members worldwide that holds annual meetings in the United States and biennial meetings in Europe. There is now a scientific journal devoted to paleopathology and another new journal in which this subject is an important emphasis. A bibliography of paleopathology (both the published edition and the supplements) contains more than 26,000 citations, many of which were published in the last 20 years (Tyson 1997).

My own research interest and experience has developed as well. In 1984 I received a three-year grant from the National Institutes of Health (NIH; grant AR 34250) to conduct a survey of pathological cases in the human skeletal collections at the National Museum of Natural History (NMNH). This survey was superimposed on a major effort by the Museum to create an electronic data base of our catalog that required that the anthropological collections be inventoried. Several people were involved in this inventory, but three members of the technical staff deserve particular mention: Marguerite (Monihan) Guthrie, who typed much of the manuscript of the first edition of this book, was responsible for creating, editing, and maintaining the data base. Dwight Schmidt and Stephen Hunter were responsible for doing the actual inventory of the human skeletal collection. This inventory required that all human remains in the collection be compared with the catalog record to ensure that the skeleton had been cataloged and that the catalog record was accurate. This meant opening thousands of drawers and handling more than 36,000 partial to complete human skeletons.

While they were engaged in this task, Schmidt and Hunter were encouraged to identify any cases of skeletal pathology and bring them to my attention. Both Schmidt and Hunter were enthusiastic and highly motivated. They became skilled at identifying pathological cases and this added immeasurably to the quality and quantity of archeological and anatomical cases of skeletal disease in the human skeletal collection of the NMNH. One of the frustrating aspects of the research Dr. Putschar and I had conducted on the NMNH pathological materials was the lack of accessble and reliable information on the archeological dating of the human remains. The grant from NIH provided funding to hire an archeologist, Dr. James Krakker, to review the archeological field records and publications to determine as accurately as possible the archeological dates for much of the human skeletal collection.

After a cluster of pathological cases had been identified, Dr. Putschar would come to the Museum for several days and the two of us would review each one, and he would dictate his observations on the pathogenesis and differential diagnosis. During these visits, Mrs. Putschar would transcribe the dictation and organize the notes. The result was the identification and documentation of many additional cases of skeletal paleopathology that added greatly to our knowledge of disease in antiquity and our ability to diagnose diseases encountered in archeological remains.

One of the interesting dimensions of this exercise was the enthusiasm with which Dr. Putschar reviewed these cases. Virtually every pathological specimen brought new knowledge and insight about pathogenesis to both of us. Because of Dr. Putschar’s vast previous experience with skeletal disease in many countries, it surprised me that he was still finding new insights as he studied these cases. The lesson he repeatedly emphasized was that archeological remains offer the potential to see the expression of disease in an entire skeleton and usually in the untreated state. This is rarely possible in a modern clinical context. He also stressed that careful observation of the type and distribution pattern of lesions within the skeletal specimen provided insight regarding pathogenesis that complemented other sources of information about the disease process.

Since 1979, research methodology has also benefitted from some major breakthroughs in technology. Computed tomography has brought new understanding to our knowledge of skeletal radiology and pathology. Archeological skeletal tissue has been found to be a remarkably good substrate for the preservation of ancient biomolecules, including DNA. Recovery of identifiable genetic material from pathogens has been reported (e.g., Kolman et al. 1999) and this is...